DISCUSIÓN

Sagittal maxillary growth in unilateral cleft lip and palate patients following functional surgery

Crecimiento sagital maxilar en fisurados unilaterales operados funcionalmente

Results of the multidisciplinary management of unilateral cleft lips and palates.

Cleft lip and palate treatment has evolved over the centuries, and it has become increasingly complex, as objectives that are higher every time are sought, with the perfection of surgical techniques and the creation of multidisciplinary teams that treat all the facets of this type of pathology, from birth until adulthood.

The different specialists involved have to be in contact from the moment of birth, juxtaposing their actions over time, as the results obtained by each of the professionals in the team can even lead to modifications in the procedure protocol.

As from the moment of birth, the assistance will be needed of an orthodontist for carrying out presurgical treatment that is aimed at aligning the alveolar arcades in order to facilitate the closure of the anterior part of the cleft and the reconstruction of the nasal floor. The point at which the lip and palate are closed, as well as the surgical technique employed, have also been shown to be determining factors when trying to obtain more positive results, that are aesthetic as well as functional.

The assistance of a speech therapist is started in early infancy, in order to use the mechanisms for phonetic compensation adequately. This treatment is continued until adolescence, as the atrophy of adenoid tissue during puberty will require phonation evaluation. The degree of velopharyngeal incompetence may be indicative of the need for carrying out complementary surgical techniques on the soft palate, or closure of oronasal fistulas. The assistance of the orthodontist will continue to be fundamental during this time, in order to control the appearance of maxillary compression because of the inclination of the maxillary segment with the cleft, before as well as after the secondary alveoloplasty, and even further on, in order to maintain adequate coordination of the arcades, and for carrying out possible preorthognatic orthodontic treatment because of hypoplasia or maxillary retrusion.

The aim of the article is to convey the results obtained following the multidisciplinary treatment of patients with cleft lips and palates, but the objective is not met, as only the aesthetic results of cleft repairs are presented, in a hotchpotch manner and with contradictions in the statistical data. In the Material and Methods section, there is a reference to an orthodontic evaluation by means of cephalometric studies, with the use of parameters that include only the position of the upper and lower maxilla. The possible secondary disturbance from palate compression, which is so frequent in these patients, is not taken into account. And, in addition, there is no reference to the findings made, or to the planning or to the results. With regard to the evaluation of the speech therapy there is more of the same.

The article could be interpreted as a presentation of the accumulated experience of the authors, but no conclusions can be drawn given the variety of techniques used, and it cannot in any way be concluded that they have expanded on the title chosen.

José Luis López-Cedrún

Servicio de Cirugía Oral y Maxilofacial Complejo
Hospitalario Juan Canalejo, La Coruña, España

References

1. Friede H, Enemark H, Sem G, Paulin G, Abyholm F, Boluund S, Lilja J, Östrup L. Craniofacial and occlusal characteristics in unilateral cleft lip and palate patients from four Scandinavian centres. Scand J Plast Reconstr hand Surg 1991;25:269- 76.

2. Sánchez-Ruiz Fernández I. Estudio evolutivo de la palatoplastia en dos tiempos en fisuras labiopalatinas completas. Tesis doctoral. Universidad del País Vasco, 1996.

3. Semb G, Shaw W. Facial growth alter different methods of surgical intervention in patients with cleft lip and palate. Acta Odontol Scand 1998;56:352-5.